Cardiac valve prosthesis

ABSTRACT

A prosthesis for implantation at an implantation site proximate a native aortic valve, the implantation site including a valve annulus and a plurality of Valsalva sinuses located distal to the valve annulus. The prosthesis comprises an armature and a valve connected to the armature, wherein the armature includes a proximal portion configured for anchorage to the valve annulus, a distal portion configured to be positioned distal to the Valsalva sinuses when the proximal portion is anchored to the valve annulus, and first, second and third Valsalva sinus anchors each extending between and connecting the proximal and distal portions and arching radially outward between the proximal portion and the distal portion. The Valsalva sinus anchors are positioned so that each can extend into and engage a wall of a different one of the Valsalva sinuses.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.14/548,013, filed on Nov. 19, 2014, which is a continuation of U.S.patent application Ser. No. 13/972,022, filed on Aug. 21, 2013, now U.S.Pat. No. 8,920,492, which is a continuation of U.S. patent applicationSer. No. 13/341,336, filed on Dec. 30, 2011, now U.S. Pat. No.8,540,768, which is a continuation of Ser. No. 12/139,686, filed on Jun.16, 2008, now U.S. Pat. No. 8,539,662, which is a continuation of U.S.patent application Ser. No. 11/352,021 filed on Feb. 10, 2006, now U.S.Pat. No. 7,857,845, which claims priority under 35 U.S.C. §119 fromItalian patent application number TO2005/A000074, filed on Feb. 10,2005. Each of the above-identified applications is hereby incorporatedby reference in its entirety for all purposes.

TECHNICAL FIELD

The present invention relates to cardiac-valve prostheses. Morespecifically, the present invention is directed to a prosthesis that isamenable to a minimally-invasive implantation.

BACKGROUND

Recently, there has been increasing consideration given to thepossibility of using, as an alternative to traditional cardiac-valveprostheses, valves designed to be implanted using minimally-invasivesurgical techniques or endovascular delivery (the so-called“percutaneous valves”). Implantation of a percutaneous valve (orimplantation using thoracic-microsurgery techniques) is a far lessinvasive act than the surgical operation required for implantingtraditional cardiac-valve prostheses. Further details of exemplarypercutaneous implantation techniques are provided in U.S. Publication2002/0042651, U.S. Pat. No. 3,671,979, and U.S. Pat. No. 5,954,766,which are hereby incorporated by reference.

These prosthetic valves typically include an anchoring structure, whichis able to support and fix the valve prosthesis in the implantationposition, and prosthetic valve elements, generally in the form ofleaflets or flaps, which are stably connected to the anchoring structureand are able to regulate blood flow.

Furthermore, the methods of implantation of valves via a percutaneousroute or by means of thoracic microsurgery are very frequentlyirrespective of the effective removal of the natural valve leaflets.Instead, the cardiac valve may be introduced in a position correspondingto the natural annulus and deployed in situ by simply divaricatingdefinitively the natural valve leaflets.

There is a need for a percutaneous valve that does not run the risk ofbeing displaced (dislodged) with respect to the implantation position,as a result of the hydraulic thrust exerted by the blood flow. There isa further need for a percutaneous valve that secures tightly to the flowduct generally defined by the natural valve annulus, such that itresists blood flow around the outside of the percutaneous valvestructure.

SUMMARY

In an exemplary embodiment, a cardiac valve prosthesis according to theinvention is made so that the entire armature of the valve, or at leastthe anchorage parts, adhere to the native walls of the implantationsite, without interfering with the blood flow, which thus remainspractically free. In a preferred way, the anchorage portions moreoverhave appropriate slits that prevent their interference with the coronaryostia. The anchorage portions and the portions of functional support ofthe armature can constitute either different parts of a single structureor parts that are structurally distinct from one another. Super-elasticmaterials can be used in order to obtain a structure that is able to becollapsed for advancement to its implantation site, and to self-recoverits expanded geometry once the prosthesis is deployed in theimplantation position. The entire armature of the valve, or at least theanchorage parts, can be made even of re-absorbable material, whereas thevalve leaflets can be made of biological and/or synthetic tissues, inpart colonizable or re-absorbable. In this way, it is possible to obtainanchorage of the device during the period necessary for integration ofthe valve prosthesis with the physiological tissues of the anatomicalsite of implantation. Subsequently, there is dissolution of theartificial structure that enables initial anchorage. Amongst the variousadvantages linked to this solution to be emphasized is the creation ofthe ideal conditions for a possible prosthetic re-implantation. Thearmature can include anchorage formations or portions of the supportingstructure of the valve flaps made at least partially of shape-memorymaterial (e.g., Nitinol) that enable creation or regulation of theanchorage, i.e., regulation of the modalities and the magnitude ofsplaying-out of the valve leaflets through control of the memory of theshape-memory material (e.g., by controlling its temperature), accordingto a mechanism similar to what is described in the document No. EP-A-1088 529.

While multiple embodiments are disclosed, still other embodiments of thepresent invention will become apparent to those skilled in the art fromthe following detailed description, which shows and describesillustrative embodiments of the invention. As will be realized, theinvention is capable of modifications in various obvious aspects, allwithout departing from the spirit and scope of the present invention.Accordingly, the drawings and detailed description are to be regarded asillustrative in nature and not restrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will now be described, purely by way of non-limitingexample, with reference to the annexed plate of drawings, in which:

FIG. 1 is a general perspective view of a cardiac-valve prosthesisaccording to one embodiment of the present invention;

FIGS. 2 to 7 illustrate different embodiments of an armature portion ofthe cardiac valve prosthesis according to the present invention;

FIGS. 8 and 9 illustrate plan and cross-sectional views, respectively,of the cardiac valve prosthesis implanted at an implantation site in apatient, according to an embodiment of the present invention; and

FIG. 10 is a schematic cross-sectional view of an implantation site forthe cardiac valve prosthesis according to one embodiment of the presentinvention.

While the invention is amenable to various modifications and alternativeforms, specific embodiments have been shown by way of example in thedrawings and are described in detail below. The intention, however, isnot to limit the invention to the particular embodiments described. Onthe contrary, the invention is intended to cover all modifications,equivalents, and alternatives falling within the scope of the inventionas defined by the appended claims.

DETAILED DESCRIPTION

In the figures of the annexed plate of drawings, the reference number 1designates as a whole a cardiac-valve prosthesis, which can be implantedpercutaneously or resorting to techniques of thoracic microsurgery, orelse of implantation of a “sutureless” type. Essentially, the prosthesis1 represented in FIG. 1 includes an armature 2, having thecharacteristics that emerge more clearly from the representation ofFIGS. 2 to 7, and a valve sleeve 3 coupled to the armature 2 andincluding three valve leaflets 3 a, 3 b, 3 c.

As illustrated in FIG. 2, the armature 2 of the prosthesis 1 can have ageneral cage-like structure, with a general symmetry of a cylindricaltype about a principal axis X1. In percutaneous valves the axis X1 isdesigned to correspond usually to the principal axis of the distal partof the catheter used for implantation of the prosthesis 1. For thepresent purpose, the axis X1 can be viewed basically as an entity of apurely geometrical nature. As shown, the armature 2 defines a lumenwhich operates as a flow tube or duct to accommodate the flow of bloodthere through. As will be readily apparent to those skilled in the art,a major characteristic of the present invention is the absence ofstructural elements that can extend in the lumen through which bloodflows.

The valve sleeve 3 may be constructed according to various techniquesknown in the art. For example, techniques for the formation of the valveleaflets, assembly of the valve sleeve and installation thereof on anarmature that can be used in the context of the present invention aredescribed in EP-A-0 133 420, EP-A-0 155 245 and EP-A-0 515 324 (all ofwhich are hereby incorporated by reference), the latter documentreferring to the construction of a cardiac-valve prosthesis ofbiological tissue of the type commonly referred to as “stentless.”

As further illustrated, the valve sleeve 3 includes a base portion 30with an overall annular pattern, designed to extend from the lowerportion of the prosthesis 1, which, in the implantation site, is in aposition proximal with respect to the direction of flow of the bloodthrough the prosthesis (from below upwards, as viewed in FIG. 1).Starting from the base portion 30, there extend in an axial directiontowards the inside of the structure of the prosthesis 1 three pleatformations 32. The valve leaflets 3 a, 3 b and 3 c extend like afestoon, with a general claw-like conformation, between pairs of pleatformations 32 adjacent to one another.

As illustrated in FIG. 1, each valve leaflet 3 a, 3 b and 3 c has afluidodynamically proximal edge with an arched pattern, which extendsfrom the base formation 30 and along two adjacent pleat formations 32,and a fluidodynamically distal edge, which extends towards the centralorifice of the prosthesis so as to be able to co-operate with thehomologous edges of the other valve leaflets. The terms“fluidodynamically proximal” and “fluidodynamically distal” refer to thedirection of free flow of the blood through the prosthesis, a directionthat is from below upwards, as viewed in the figures of the annexedplate of drawings.

As will be understood by those of ordinary skill in the art, inoperation, the valve leaflets 3 a, 3 b, 3 c are able to undergodeformation, divaricating and moving up against the armature 2 so as toenable free flow of the blood through the prosthesis. When the pressuregradient, and hence the direction of flow, of the blood through theprosthesis tends to be reversed, the valve leaflets 3 a, 3 b, 3 c thenmove into the position represented in FIG. 1, in which theysubstantially prevent the flow of the blood through the prosthesis.Usually, the valve leaflets 3 a, 3 b, 3 c are made in such a way as toassume spontaneously, in the absence of external stresses, the closedconfiguration represented in FIG. 1.

FIGS. 2 through 7 depict the armature 2 according to various embodimentsof the present invention. Referring first to FIG. 2, it is shown thatthe armature 2 (which may be made of metal material, such as for examplethe material commonly referred to as Nitinol) includes two annularelements 20 a, 20 b, which generally occupy respective end positionswithin the armature 2. In one embodiment, in the site of implantation ofthe prosthesis 1, the annular elements 20 a and 20 b are designed to belocated, respectively, upstream and downstream of the sinuses ofValsalva.

During implantation, the prosthesis 1 is advanced towards theimplantation site in a radially contracted configuration, with theannular elements 20 a and 20 b in a radially collapsed configuration. Inone embodiment, when so collapsed, the annular elements 20 a, 20 b havea minimum diameter of about 5 to about 15 mm, according to the techniqueof implantation for which the prosthesis is designed. Once theprosthesis 1 has reached the implantation site, the annular elements 20a, 20 b are made/allowed to expand until they reach their normalexpanded configuration, with a diameter that ranges, in one embodiment,from about 18 to about 30 mm.

In order to enable the movement of expansion, the annular elements 20 aand 20 b are made, according to the illustrated embodiment, with a meshstructure substantially resembling the mesh structure of a stent forangioplasty. It will be appreciated in fact that the annular elements 20a and 20 b are designed to perform a movement of radial expansion (withsubsequent maintenance of the radially expanded configuration)substantially resembling the movement of expansion in situ of anangioplasty stent.

In the example of embodiment illustrated herein, the annular elements 20a and 20 b have a rhomboidal-mesh structure. In other embodiments, theparts 20 a, 20 b can be made with any structure that is able to ensurethe necessary functionality.

In one embodiment, as shown in FIG. 2, the annular element 20 a designedto be located in a position proximal with respect to the flow of theblood through the prosthesis 1 (i.e., on the inflow side of the blood inthe prosthesis 1 in the conditions of free flow) may have a proximal endthat is at least slightly flared outward like an enlarged opening of theflow duct of the blood. This configuration functions to promote a morepositive anchorage of the annular element 20 a, and in turn, theprosthesis 1, to the valve annulus, thus promoting the perivalvartightness, improving the haemodynamics, and adapting (i.e., radiusing)the lines of blood flow in the ventricular chamber to the flow tubeconstituted by the valve sleeve.

As shown, the annular elements 20 a, 20 b are connected to one anotherby anchor members 22, which in the illustrated embodiment, are generallyarched, projecting towards the outside of the prosthesis 1. In oneembodiment, the anchor members 22 are designed such that when theprosthesis 1 is positioned at the implantation site, the anchor members22 can extend on the outside of the sinuses of Valsalva so as to ensurefirm anchorage in situ of the prosthesis 1.

With the prosthesis 1 in the radially contracted configuration adoptedfor implantation, the anchor members 22 are normally maintained in aposition (not shown) recalled towards the central axis X1 of theprosthesis 1. This can occur, for example, via a retention means such asa tubular sheath of an implantation catheter through which the radiallycontracted prosthesis is advanced. Subsequently, once disengaged fromthe retention means, the anchor members 22 may assume the arched patternrepresented in the figures so as to be able to project (protrude), inone embodiment, within the sinuses of Valsalva.

As will be appreciated by those skilled in the art, the sinuses ofValsalva are, in a normal heart, three in number, and are distributed inan approximately angularly uniform way around the root of the arterydistal to the semilunar valve (i.e., the aortic or pulmonary valve).Accordingly, as illustrated, the prosthesis 1 may include three anchormembers 22 (or three groups of anchor members) set at an angulardistance apart of about 120° with respect to the central axis X1 of theprosthesis.

In the exemplary embodiment illustrated, the anchor members 22 are madein the form of ribbon-like elements that extend in a generallysinusoidal or serpentine path, with bends or open loops situated oneither side with respect to an ideal line extending approximately in thedirection of the generatrices of the overall cylindrical shape of theprosthesis. In another embodiment of the invention, the sinusoidalpattern can be obtained with bends or open loops that extend from oneside and from the other with respect to a line that extends in acircumferential direction with respect to the prosthesis. In yet anotherembodiment, the anchor members 22 may have a mesh structure, for exampleclosed rhomboidal meshes of the same type as the one represented withreference to the annular elements 20 a, 20 b, or to simple segments ofcurve lying in roughly radial planes. Additionally, as discussed above,each anchor member 22 can consist either of a single element or of aplurality of elements (e.g., pairs of anchor members 22 as shown inFIGS. 2-7) that extend in a direction in which they are generally setalongside one another.

The annular elements 20 a and 20 b and the respective anchor members 22substantially form the basic structure of the armature 2 of theprosthesis 1, which is designed to ensure positioning and anchorage insitu of the prosthesis 1 itself.

Associated then to the annular elements 20 a and 20 b are furthersupport members, generically designated by 24 in all of FIGS. 2 to 7,which operate to support the valve sleeve 3 on the armature 2 of theprosthesis 1. In the embodiment represented in FIG. 2, the supportmembers 24 are simply represented by three generally flat bars extendingbetween and connecting the annular members 20 a, 20 b. As furtherillustrated, the support members 24 are set at an angular distance apartof about 120°, with each generally located at a position that isapproximately centrally intermediate the anchor members 22.

As may be appreciated from a comparative examination of FIGS. 1 and 2,the support members 24 are designed to enable the installation of thevalve sleeve 3 in a condition such that the base portion 30 thereof isarranged in general in a position around the annular element 20 a of thearmature 2, while each of the pleat formations or folds 32 in turnembraces one of the elements or support members 24, while the valveleaflets 3 a, 3 b and 3 c extend in a festoon, each between two adjacentsupport members 24. The general apertured structure both of the annularelement 20 a and of the support members 24 (note the particular holesdesignated by 26) enables fixing of the valve sleeve 3 on the armature 2by, for example, suturing stitches according to known techniques. In thecase where flaps of polymeric materials are used, the flaps can beformed directly on the structure, using techniques such as, for example,dip casting.

In this regard, both the armature 2 and the aforesaid suturing stitchescan be advantageously provided with a coating of biocompatible carbonmaterial, which may be applied according to the solutions described inU.S. Pat. No. 4,624,822, U.S. Pat. No. 4,758,151, U.S. Pat. No.5,084,151, U.S. Pat. No. 5,133,845, U.S. Pat. No. 5,370,684, U.S. Pat.No. 5,387,247, and U.S. Pat. No. 5,423,886, the contents of which arehereby incorporated by reference.

The apertured structure of the supporting formations 24, and of thearmature 2 in general, means that the armature 2 does not exert anysubstantial obtrusive effect, preventing, for example, interference inregard to the coronary ostia.

FIG. 3 depicts an alternative embodiment of the armature 2 of thepresent invention. The variant embodiment represented in FIG. 3 as awhole resembles the embodiment represented in FIG. 2, with the exceptionthat (in the embodiment of FIG. 3) the support members 24 provided foranchorage of the valve sleeve 3 do not extend completely in bridge-likefashion between the two annular parts 20 a and 20 b. Rather, in theembodiment illustrated in FIG. 3, the support members 24 are projectingelements that extend in cantilever fashion starting from the annularelement 20 a, and do not reach the annular element 20 b. In particular,the lengths of the aforesaid cantilevered support members 24 aredetermined in such a way as to extend for a length sufficient to enableanchorage of the valve sleeve 3 to the support members 24 at the pleatformations 32. Thus, in one embodiment, the support members 24 do notinclude any portions other than those portions which operate to supportthe valve sleeve 3.

FIG. 4 illustrates another embodiment of the armature 2 according to thepresent invention. As shown, in the embodiment of FIG. 4, like thatshown in FIG. 3, the support members 24 project in cantilever fashionfrom the annular element 20 a. As further shown in FIG. 4, in thisembodiment, the support members 24 have associated thereto fork-likestructures 28. Each fork-like structure 28 has a root portion connectedto the annular element 20 b and two prongs that extend on either side ofthe respective support member 24 and then connect up to the annularelement 20 a on opposite sides with respect to the area in which thesupport member 24 projects in cantilever fashion from the formation 20a.

As further shown in FIG. 4, in one embodiment, the support members 24are generally tapered, such that they have widths that decreasegradually moving away from the annular element 20 a, that is, in theproximal-to-distal direction with reference to the direction of freeflow of the blood through the prosthesis. As will be apparent to thoseskilled in the art, tapering of the support members 24 may be employedin any of the embodiments illustrated in FIGS. 2 to 4. Similarly, any ofthe other characteristics of the support members 24 or the anchormembers 22, which albeit herein represented are identical to one anotherin each of the embodiments illustrated, could in actual fact bedifferent from one another. That is, in any embodiment of the valveprosthesis 1, there could coexist, in a single prosthesis, anchormembers 22 or support members 24 different from one another, withcharacteristics drawn from different embodiments amongst the pluralityof embodiments illustrated herein.

The solution represented in FIG. 4 generally provides a more rigidanchorage structure as compared to the embodiment of FIG. 3. In theembodiment illustrated in FIG. 4, the fork-like formations 24effectively fix the axial dimension of the prosthesis 1, which promotesthe expansion of the anchor members 22 in the sinuses of Valsalva. Atthe same time, in the illustrated embodiment of FIG. 4, the supportmembers 24, which operate to facilitate attachment of the valve sleeve 3to the armature 2, are maintained flexible and of modulatable stiffness.

In the embodiment represented in FIG. 5, the support members 24 areprovided in positions corresponding to both of the annular elements 20a, 20 b. In this case, however, the support members 24 provided foranchorage of the valve sleeve 3 are reduced to small hookingcantilevers, each provided with an eyelet 26. The eyelets 26 can be useddirectly for passing and tying the wires that extend from the valvesleeve 30.

Yet another embodiment is shown in FIG. 6, in which the support members24 are arranged in opposed pairs, with each of the support members 24within a pair extending in cantilever fashion from one of the annularelements 20 a, 20 b and being connected by a connecting element 34. Inone embodiment, the connecting elements 34 may have a generally filiform(i.e., relatively long and thin) shape, whereby the connecting elements34 may be made relatively flexible and thus may provide a flexibleconnection between the support members 24. In one embodiment, theconnecting elements 34 may be made from biocompatible metal alloys(e.g., Nitinol) or polymeric materials suitable for applications in thefield of implantations (e.g., acetal resins).

As shown, the overall configuration of the embodiment of FIG. 6generally resembles, from a geometrical standpoint, the embodimentrepresented in FIG. 2. The difference lies in the fact that, whereas thesupport members 24 represented in FIG. 2 are as a whole generally stiff(taking into account the intrinsic flexibility of the material thatconstitutes them), the connecting elements 34 shown in FIG. 6 may have afiliform shape with a relatively high flexibility. The embodimentillustrated in FIG. 6 thus enables the configuration for hooking of thevalve sleeve 3 to the armature 2 of the prosthesis to be renderedelastic/flexible and renders the extent of the anchor members 22independent of that of the support members 24, thus enabling a greaterelasticity of design.

FIG. 7 depicts yet another embodiment of the armature 2, which isotherwise similar to the embodiment illustrated in FIG. 6, except thatin the embodiment of FIG. 7, the mutually facing pairs of supportmembers 24 are not connected to each other (as by the connecting members34 in FIG. 6). Instead, in the embodiment represented in FIG. 7, asupporting element 36 extends between and connects each of the supportmembers 24 extending in cantilever fashion from the annular element 20b. As shown, the supporting elements 36 may extend in a generallyfestoon-like or catenary path between each of the support members 24attached to the annular part 20 b. The supporting elements 36 areconfigured such that each can support one of the valve leaflets 3 a, 3b, or 3 c of the valve sleeve 3. The supporting elements 36 may be madeof substantially rigid or flexible materials.

In another embodiment (not shown), the supporting elements 36 may beconfigured to extend from the support members 24 extending in cantileverfashion from the annular element 20 a.

As will be readily understood by those skilled in the art, festoon-likeor catenary pattern of the supporting elements 36 may be generallyconfigured to match the homologous pattern of the proximal edges of thevalve leaflets 3 a, 3 b and 3 c (see FIG. 1), defining the profile ofthe edge for anchorage of the functional flaps and, possibly, enablingconnection by suture of the aforesaid proximal edges of the valveleaflets to the festoon-like supporting elements 36. This enables theuse of relatively simple valve sleeves 3, assigning the formation of theprofile of the functional flaps of the valves to the supporting elements36.

The embodiments of the present invention described herein enables, inthe final position of implantation, the entire armature 2 of theprosthesis 1, or at least the anchorage parts, to adhere to the nativewalls of the implantation site, without interfering with the blood flow,which thus remains practically free. Additionally, the armature 2 andanchor members 22 moreover have a generally apertured structure (forexample, appropriate slits), which prevents interference with thecoronary ostia.

The anchorage portions and the portions of functional support of thearmature 2 can constitute either different parts of a single structureor parts that are structurally distinct from one another. The entirearmature 2, or at least the anchorage parts (e.g., the anchor members22), may be made of re-absorbable material, whereas the valve sleeve 3can be constituted by biological and/or synthetic tissues, which are inpart colonizable or re-absorbable.

Alternatively, as discussed above, the armature 2 can contain anchorageformations (e.g., anchor members 22) made at least partially ofshape-memory material (e.g., Nitinol), which enable creation orregulation of the anchorage through the control of the memory of theshape-memory material (e.g., controlling its temperature).

FIGS. 8 and 9 illustrate plan and cross-sectional views, respectively,of the prosthesis 1 in its implanted state in an aortic valvereplacement, according to an embodiment of the invention. As shown, andas discussed in detail above, the prosthesis 1 can be implanted suchthat the annular elements 20 a and 20 b occupy positions proximal anddistal, respectively, of the Valsalva sinuses VS, with the flaredproximal end of the annular member 20 a forming the proximal entrance ofthe lumen defined by the armature 2 of the prosthesis 1. In theillustrated embodiment, the anchor members 22 can be arranged in threepairs positioned relative to the sinuses of Valsalva such that theradially projecting portion of each of the anchor members 22 projectsinto the respective sinus of Valsalva and engages the aortic walltherein. As further shown, the anchor members 22 of each pair can bepositioned on opposite sides of the coronary ostia CO in the respectivesinuses of Valsalva. Additionally, as discussed above and shown in FIGS.8 and 9, the serpentine or otherwise generally apertured structure ofthe anchor members 22 substantially avoids interference with thecoronary ostia CO. Finally, as can be seen from FIGS. 8 and 9, the valveleaflets 3 a, 3 b, 3 c can be positioned within the lumen for blood flowformed by the annular elements 20 a, 20 b, with the support members 24extending into the lumen by a minimal amount.

The armature 2 of the prosthesis 1, according to one embodiment, ismanufactured by first cutting a blank part from a tube of abiocompatible metal (e.g., Nitinol, or a cobaltum-chromium alloy) havingan outer diameter which is at an intermediate size between the fullyradially contracted and the fully expanded device dimensions. Forexample, the tube may have an outer diameter of between about 8 mm toabout 14 mm. In one embodiment, the tube has a diameter of about 10 mm.In one embodiment, the tube wall may vary between about 0.3 mm to about0.5 mm, depending on the required stiffness required and the size of theprosthesis 1.

In one embodiment, the final dimension and shape of the framework isachieved by a sequence of expansion cycles. A specific heat treatment isapplied after each expansion cycle to homogenize and stress relieve thematerial, which allows the shape and properties of the structure of thearmature 2 to be set. Although the number of forming steps may varyamong devices, for the geometries described above with respect to thepresent invention, and using Nitinol for the tube blank, an exemplarynumber of forming steps is around three. Among these steps, the firsttwo provide the final diameter of the annular elements 20 a, 20 b. Forexample, if the fully-expanded diameter for implantation is 23 mm, thefinal cylindrical shape of the armature 2 can be achieved using a tubeblank of about 10 mm in diameter, a first expansion from about 10 mm toabout 18 mm, and a second expansion from about 18 mm to about 23 mm.Optionally, the final diameter can be made slightly larger (e.g. about25 mm in the previous example) in order to oversize the armature 2 withrespect to the physiological annulus, thus imparting a radial force tothe wall of the annulus at the nominal implant diameter.

The third forming step is aimed to impart the radially extending shapeof the anchor members 22 such that they will fit and anchor within theValsalva sinuses. The corresponding heat treatment, according to oneembodiment, includes exposing the deformed armature 2 to a temperaturefrom about 480° C. to about 550° C., for a time ranging from about 5minutes to about 30 minutes, depending on the desired finaltransformation temperature. For example, in order to obtain asuper-elastic behavior at 37° C. (the normal working condition in humanbody) the heat treatments subsequent to the two initial expansion stepsmay be performed at about 480° C. for a time of about 9 minutes, and thefinal heat treatment (after the third expansion) is performed at about500° C. for a time of about 9 minutes.

After the forming process is complete, the armature 2 may undergo one ormore surface treatments, for example, sandblasting and electropolishing,to provide a sufficiently smooth surface and to remove the shallowdefects. The armature 2 may thereafter be finally exposed to a carboncoating process in order to improve its hemocompatibility.

As shown in FIGS. 8-9, for an aortic valve replacement, the finalgeometrical shape of the armature 2 will generally approximate thephysiological shape and dimension of the aortic root, such that theanchor members 22 generally conform to the walls of the respectiveValsalva sinuses VS.

FIG. 10 shows a schematic cross sectional view of an implantation sitefor an aortic valve replacement. Referring to FIG. 10, exemplaryproportions of the relevant features at the implantation site for anaortic valve replacement are as follows (assuming the annulus diameterD_(imp) (implanting diameter) equal to 1):

Approximate Approximate Minimum Maximum Height of Valsalva 0.8 1 sinuses(H): Max. diameter of 1.3 1.7 Valsalva sinuses (Dmax): Distance between0.3 0.5 Valsalva max. diameter and basic annulus plane (Hmax): Diameterat the 0.8 1.4 sino-tubular junction (Dstj):

According to one exemplary embodiment, H is about 0.9, Dmax is about1.5, Hmax is about 0.35, and Dstj is about 1.2.

The commissural points of the elastic collapsible valve 3 are mounted tothe armature 2 (e.g., by attachment to the support members 24) such thatthe valve leaflets 3 a, 3 b, and 3 c can fold and expand together. Thevalve 3, including the valve leaflets 3 a, 3 b, 3 c, can be, forexample, a glutaraldehyde fixed pericardium valve which has three cuspsthat open distally to permit unidirectional blood flow.

In one embodiment, the valve member may use two pericardium sheets. Thefirst sheet forms the three moving cusps, the second sheet coats part ofthe armature 2 surface so that there is no contact between the armature2 and the valve leaflets avoiding the risk of abrasion due to repeatedimpact against the metallic material of the armature 2. In addition,this second sheet redistributes the stress applied by blood pressure onthe prosthetic leaflets, avoiding the risk of stress concentration.

The two sheets of pericardium may be stitched together flat using suturethread coated with a film of biocompatible material, and then close in acylindrical shape. The type of stitch used may be varied to accommodatethe directional differences in the forces exerted at each point of thesuture, to ensure that the stitches themselves don't become the originof fatigue fracture lines. The two sheets may be stitched together in aflat position so when the leaflets open they recover their originalcylindrical configuration, forming a cylindrical duct.

The elastically collapsible valve sleeve 3 can be mounted on thearmature 2 by means of a number of suture stitches. Both of the sheetsare useful for attaching the valve sleeve 3 to the armature 2 bystitching.

The valve member can use a tissue fixation and shaping of the leaflets 3a, 3 b, 3 c by means of a fluidic, atraumatic system with chemicalsuseful for cross-linking and then may be exposed to a detoxificationpost treatment to increase long-term performance. An additionalpericardium sheet corresponding to base portion 30 of the valve sleeve 3can be positioned in a generally cylindrical fashion around the annularelement 20 a so as to improve the sealing capability of the prosthesis 1to the valve annulus.

Various modifications and additions can be made to the exemplaryembodiments discussed without departing from the scope of the presentinvention. Accordingly, the scope of the present invention is intendedto embrace all such alternatives, modifications, and variations as fallwithin the scope of the claims, together with all equivalents thereof.

We claim:
 1. A prosthesis for implantation at an implantation siteproximate a native aortic valve, the implantation site including a valveannulus and three Valsalva sinuses located distal to the valve annulus,the prosthesis comprising: an armature and a valve connected to thearmature, wherein the armature includes: a proximal portion configuredfor anchorage to the valve annulus; a distal portion configured to bepositioned distal to the Valsalva sinuses when the proximal portion isanchored to the valve annulus; and first, second and third Valsalvasinus anchors each extending between and connecting the proximal anddistal portions and arching radially outward between the proximalportion and the distal portion, the Valsalva sinus anchors positioned sothat each can extend into and engage a wall of a different one of theValsalva sinuses.
 2. The prosthesis of claim 1, wherein the first,second and third Valsalva sinus anchors each include a pair of anchormembers, wherein each of the anchor members extends between and connectsthe proximal and distal portions and arches radially outward between theproximal portion and the distal portion.
 3. The prosthesis of claim 2,wherein each of the anchor members has a generally sinusoidal shape. 4.The prosthesis of claim 1, wherein the first, second and third Valsalvasinus anchors each have a mesh structure.
 5. The prosthesis of claim 1,wherein the proximal and distal portions each have a mesh structure. 6.The prosthesis of claim 1, wherein the armature is radially collapsibleto a delivery configuration.
 7. The prosthesis of claim 1, wherein thearmature further includes first, second and third valve support membersconnected to the proximal portion and extending from the proximalportion toward the distal portion, and wherein the valve is connected tothe valve support members.
 8. The prosthesis of claim 7, wherein thefirst, second and third valve support members are each connected to thedistal portion.
 9. The prosthesis of claim 7, wherein the first valvesupport member is positioned between the first and second Valsalva sinusanchors, the second valve support member is positioned between thesecond and third Valsalva sinus anchors, and the third valve supportmember is positioned between the third and first Valsalva sinus anchors.10. The prosthesis of claim 1, wherein the proximal portion of thearmature has an outwardly-flared proximal end.
 11. A prosthesis forimplantation at an implantation site proximate a native aortic valve,the implantation site including a valve annulus and a plurality ofValsalva sinuses located distal to the valve annulus, the prosthesiscomprising: an armature and a valve sleeve including a plurality ofvalve leaflets connected to the armature, wherein the armature includes:a proximal portion configured for anchorage to the valve annulus; adistal portion configured to be positioned distal to the Valsalvasinuses when the proximal portion is anchored to the valve annulus; anda plurality of Valsalva sinus anchors each extending between andconnecting the proximal and distal portions and arching radially outwardbetween the proximal portion and the distal portion, the Valsalva sinusanchors positioned so that each can extend into and engage a wall of adifferent one of the Valsalva sinuses.
 12. The prosthesis of claim 11,wherein the Valsalva sinus anchors each include a pair of anchormembers, wherein each of the anchor members extends between and connectsthe proximal and distal portions and arches radially outward between theproximal portion and the distal portion.
 13. The prosthesis of claim 12,wherein each of the anchor members has a generally sinusoidal shape. 14.The prosthesis of claim 11, wherein the Valsalva sinus anchors each havea mesh structure.
 15. The prosthesis of claim 11, wherein the proximaland distal portions each have a mesh structure.
 16. The prosthesis ofclaim 11, wherein the armature is radially collapsible to a deliveryconfiguration.
 17. The prosthesis of claim 11, wherein the armaturefurther includes a plurality of valve support members connected to theproximal portion and extending from the proximal portion toward thedistal portion, and wherein the valve sleeve is connected to the valvesupport members.
 18. The prosthesis of claim 17, wherein the valvesupport members are each connected to the distal portion.
 19. Theprosthesis of claim 11, wherein the plurality of Valsalva sinus anchorsincludes a first, a second and a third Valsalva sinus anchor, theplurality of valve support members includes a first, a second and athird valve support member, and wherein the first valve support memberis positioned between the first and the second Valsalva sinus anchors,the second valve support member is positioned between the second and thethird Valsalva sinus anchors, and the third valve support member ispositioned between the third and first Valsalva sinus anchors.
 20. Theprosthesis of claim 11, wherein the proximal portion of the armature hasan outwardly-flared proximal end.